Canadian College of Shiatsu Therapy

 

Application Form

 

(Please check  the Course/Program you are applying)

 

   □The 2000-hour Shiatsupractor® Diploma Program
                □Full-time □Full-time International □Part-time □Upgrading

   □The Shiatsu Therapist Certificate Course

   □The Chair-Shiatsu Certificate Course 

   □The Shiatsu Foundation Certificate Course 

   □Other Certificate Course

 

Course / Program # or Course / Program Starting date

[                        ]

   

   Introducers' Name:                             Tel:                        E-mail:                                      

     (If there is a person who referred you to the CCST, please inform us the name. )

 

 

 

   
Name: Date of Birth:
                 (last)                                (first)                                  (middle)                                (day)                   (month)                  (year)
   
Address:
                      (apt)              (street)                   (city)                          (province)                     (country)                    (postal code)
 
Tel. Res: Bus.: Fax.: E-mail:
       
Citizenship: Signature : Date of Application:
   
   
In Case of an emergency notify:  
       
Name:    
                (last)                           (first)                             (middle)    
     
Address:
                        (apt)             (street)                (city)                           (province)                        (country)                     (postal code)
 
Tel. Res: Bus.: Fax.: E-mail:

Note:

Please include the following with your application :

  1. Your resume
  2. Proof of high school, college or university graduation - Copy of Diploma and / or Certificate
  3. A letter of recommendation (e.g. from employer or non-family member)
  4. A letter indicating why you want to become a Shiatsupractor and what previous experience you have in this area. 
  5. A certificate of health from a medical doctor stating that you are in good health and free from communicable disease. (please provide a history of contagious diseases.)
  6. A clean criminal record (local students only)
  7. A $100.00 non-refundable application fee made payable to the Canadian College of Shiatsu Therapy Inc. which will be applied to your tuition fees once approved. (If not approved your application fee will be returned to you)

 Note:  1-6 are only applied for the 2000-hour Shiatsupractor Diploma programs and the Shiatsu Therapist Certificate Course.

 

 Mailing Address:

Canadian College of Shiatsu Therapy@142 Lonsdale Avenue, North Vancouver, BC V7M 2E8

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